Section 127.607. Peer review—conflicts of interest

Latest version.

(a) A PRO shall return a request for peer review to the Bureau for reassignment if the following apply:
(1) The PRO has a previous involvement with the patient or provider under review in the same matter.
(2) The PRO has performed precertification functions in the same matter.
(3) The PRO has provided case management services in the same matter.
(4) The PRO has provided vocational rehabilitation services in the same matter.
(5) The PRO is owned by or has a contractual relationship with any party subject to the review.
(b) A PRO shall inform the reviewer assigned to perform peer review of the reviewer’s obligation to notify the PRO of any potential or realized conflicts arising under § 127.615 (relating to duties of reviewers—conflict of interest)

                    
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